Colorado Cancer BlogsNews from the University of Colorado Cancer Center2015-03-03T15:00:10Zhttp://www.coloradocancerblogs.org/feed/atom/WordPressTaylor Bakemeyerhttp://www.coloradocancerblogs.org/?p=92352015-02-27T18:01:45Z2015-03-03T15:00:10Z“Thank you for being a hero.” On February 7, Michael Glode, MD, CU Cancer Center...

On February 7, Michael Glode, MD, CU Cancer Center member, was awarded the EPIC Hero Award at the third annual Hearts and Hope Gala. The gala is the largest event EPIC Experience puts on during the year. Epic Experience is a non-profit organization that offers free week-long outdoor experiences to individuals who have been diagnosed with cancer.

The 2015 gala started a new tradition.

“This year we wanted to start an annual award that would acknowledge the medical community that supports cancer survivors every day,” says Nancy Ferro, founder of EPIC Experience. “Mike was an easy pick as he has done so much for cancer survivors across the country and here in Colorado.”

Glode is deeply involved with EPIC Experience. He has volunteered at two camps and is part of the medical advisory team for the organization.

“The EPIC experience is a wonderful event for cancer survivors and many of our patients at University of Colorado Cancer Center have been able to take part,” says Glode. “Watching people stretch their limits by going kayaking on the Colorado River and then share their hearts around a campfire at night is special, and I have enjoyed being a part of the program as a medical volunteer.”

It is clear in a video that EPIC Experience produced that Glode is considered a hero by many, yet he modestly suggests otherwise.

“I was surprised and very humbled to be singled out for the EPIC Hero award, particularly since it was their first year giving it out, and I think the real heroes for EPIC are the Ferro family who got it all started,” he says.

With long blonde hair, a fit physique, and an overwhelmingly positive attitude, Katy Davenport hardly looks like someone who is enduring cancer. Yet at 34 years old Katy went in for a precautionary colonoscopy after noticing some blood in her stool. Her doctor was shocked to discover a tumor.

“When we went in we honestly thought it would be nothing,” Katy says. “It was truly a shock for both me and my husband to find out that I had a tumor, especially because there is no history of colon cancer in my family.”

A biopsy confirmed that the tumor was malignant and on New Year’s Eve Katy was diagnosed with stage three colon cancer. After talking to some friends she quickly turned to the University of Colorado Cancer Center for a second opinion. Christopher Lieu, MD, investigator at the CU Cancer Center and assistant professor of medical oncology at the University Of Colorado School Of Medicine, became her oncologist.

“The hardest part was waiting,” she says. “It took about a week for the scans to get to Dr. Lieu and once he confirmed the stage three diagnosis we immediately scheduled a surgery.”

On January 20, 2015 Katy had surgery to remove the tissue. Jon Vogel, MD, was the lead surgeon on the team.

“Dr. Vogel was amazing,” Katy says. “He answered all the questions I had, really listened to me, and made me feel like an actual person.”

The surgery was a success however the removal of the tumor is only the start of Katy’s cancer journey. On February 24 she will start chemotherapy and for the next six months she will have to come for treatment every two weeks.

“We find that young adult colon cancer tends to be much more aggressive than cancer in the older population,” says Lieu. “We are unsure of why this is but we’ll certainly be studying her tumor to see what we can learn to treat and prevent this cancer in the future!”

Despite the long months ahead Katy has found some positivity in her chemo treatments.

“I get to keep my hair!” she smiles. “I feel very blessed that my specific type of chemotherapy allows me to do that. It might not be a big deal but it allows me to keep some normality in my life.”

Although a cancer diagnosis is hard for anyone at any stage in life Katy finds it difficult to be dealing with a cancer typically diagnosed in the older population.

“In the waiting rooms the other patients are usually people twice my age,” she says. “We are in two very different stages of life and it can be hard to find people who are going through a situation similar to mine.”

However Katy has found support through her friends and family, which helps her maintain her positive attitude.

“If I could give advice to not only young cancer patients, but all patients, it would be to try and keep a good attitude and keep finding things to smile about,” she says. “Also be sure to take care of yourself and make sure you do what you need to do.”

Katy has also become a huge advocate for screening and early detection.

“Before all of this I had no idea that March was colon cancer awareness month, but now that I am here I am all for knowing your family history and getting screened,” she says. “If something seems off do not be afraid to go and see you doctor!”

Joanne Hilden, MD, and colleagues show that young cancer patients with fever and neutropenia have less intensive care needs and lower mortality when receiving antibiotics within an hour of arrival at the hospital.

A University of Colorado Cancer Center study published in the journal Pediatric Blood & Cancer shows that pediatric cancer patients who receive antibiotics within 60 minutes of reporting fever and showing neutropenia (low neutrophil count), go on to have decreased intensive care needs and lower mortality compared with patients who receive antibiotics outside the 60-minute window.

“We’re talking about kids who have gone home after chemotherapy and then a parent calls the hospital reporting a fever. The question is can we get the patient back to the hospital, then get a white cell count, and get antibiotics on board when needed all within an hour of their arrival? It’s a huge challenge. This study shows that it’s important we make it happen: there’s less intensive care and fewer fatalities for kids who get antibiotics sooner,” says Joanne Hilden, MD, investigator at the CU Cancer Center, director of clinical services for pediatric oncology at Children’s Hospital Colorado, and the paper’s senior author.

Specifically, the paper shows in a sample of 220 children that mortality was 3.9 percent for patients who received antibiotics outside 60 minutes and only 0.7 percent for those who received antibiotics within the hour.

The study took place within efforts of Children’s Hospital Colorado to improve time-to-delivery of antibiotics in cases of fever and low white blood cell count in pediatric cancer patients, which at study outset required an average 150 minutes. The paper describes procedural changes including prescribing antibiotics upon a pediatric cancer patient’s arrival to the hospital, holding that order, then allowing the delivery of antibiotics to start immediately after learning the results of neutrophil count testing (eliminating the need to find a prescriber once the white blood cell count was known).

Another intervention describes speeding the time needed to determine the neutrophil count. Traditionally, determining neutropenia requires a full white blood cell count followed by “differential” (counting the percent neutrophils) by a human technician. But human verification reverses the preliminary, machine results in less than 0.5 percent of cases. Analysis showed that the benefit of speed outweighed the risk of administering unneeded antibiotics in these very few cases. Depending on preliminary rather than technician-verified results of white cell counts reduced the time of testing from 45 minutes to twenty.

“Another thing we show is that just increasing the awareness of how important it is to get antibiotics on board quickly in these cases speeds delivery,” Hilden says.

Taken together, along with changes to clinic flow procedures that included notifying the full care team as soon as the family is advised to come into the hospital and a STAT intake, Children’s Hospital Colorado was able to reduce its time to delivery of antibiotics to a median 46 minutes, with nearly 100 percent of pediatric patients with fever and neutropenia receiving antibiotics within 60 minutes.

“We’re a top children’s cancer institution where we deliver medicines based on the latest molecular genetics. And even if you get all that stuff right, you still have to take care of the patient’s body during treatment. Nothing makes you madder than losing to infection,” Hilden says. “Only eleven percent of pediatric cancer patients with fever and neutropenia have serious complications. That’s low. But we can make it zero, and this study shows that getting antibiotics onboard quickly goes a long way toward that goal.”

]]>0Taylor Bakemeyerhttp://www.coloradocancerblogs.org/?p=92172015-02-25T16:13:09Z2015-02-25T16:13:09ZThe University of Colorado Cancer Center welcomed students from four different local high schools to...

The University of Colorado Cancer Center welcomed students from four different local high schools to come and tour the Anschutz Medical Campus at Learn about Cancer Day. The unique event encourages students to continue their interest in science and even pursue a career in cancer research.

Over 120 seniors and juniors from East High School, Green Valley Ranch STEM School, Overland High School, and Ralston Valley High School took part in the 2015 event. Students listened to lectures about cancer, toured two cancer research labs, and ended the afternoon by talking to a panel of young breast cancer survivors and learning about their experiences. For many, listening to the survivors was the highlight of the event.

“I thought my favorite part of this would be the lab tours but listening to the three ladies and their stories actually was the best part,” one student said.

Learn about Cancer Day started in 2009 and has grown tremendously through the years.

“When we first started the program we focused on schools that are close to the campus,” explains Jill Penafiel, education coordinator for the University of Colorado Cancer Center. “Since then we have had 15 schools from many area school districts come and take part in the event.”

Students that participate in Learn about Cancer Day are typically in AP, IB, or honors science classes and have expressed interest in the science field. Many students wish to go on to graduate or medical school.

“We hope this event will spark interest in young people to pursue a career in science, research, or maybe even cancer,” Penafiel says. “We also hope that is will broaden the community awareness about cancer treatment options they have in their own back yard.”

Sidharth Tripathi is a sophomore at Colorado College. He participated in both Learn about Cancer Day as well as two summer fellowships in the Cancer Research Summer Fellowship Program at the CU Cancer Center. . He is just one of many students who have been inspired to pursue a career in research because of the unique event.

“Learn about Cancer Day opened my eyes to just how pivotal of a role cancer research plays in saving lives. Prior to attending the conference, I really had no idea what it meant to be a researcher in the biomedical sciences,” he says. “After to listening to some of the talks and presentations, I felt motivated to somehow make my own impact in the realm of cancer research.”

A University of Colorado Cancer Center study published today in the journal Molecular Cancer Therapeutics shows that only about 1 percent of triple-negative breast cancer cells in a tumor must be “androgen-receptor-positive” to show benefit from anti-androgen therapies. There are no FDA-approved targeted therapies for triple-negative breast cancer. Clinical trials currently underway are showing promising preliminary results of anti-androgen-receptor therapies against triple-negative breast cancers expressing a higher percentage of androgen-receptor-positive cells.

“What we’re showing is that the threshold for benefit from anti-androgen-receptor therapies in triple-negative breast cancer may be far lower than we previously thought. This is an extremely optimistic finding for many people who have been without options for targeted cancer therapy,” says Valerie Barton, the study’s first author and PhD candidate in the lab of CU Cancer Center investigator Jennifer Richer, PhD.

Triple-negative breast cancers are those without known hormone or genetic drivers – specifically, breast cancers that do not drive their growth with the hormones estrogen or progesterone, or with the gene HER2. Without a known driver, there has been no “target” in triple-negative breast cancer to treat with targeted therapies, and the triple-negative subtype has the worst five-year survival rate of any breast cancer. The current study is the most recent in an extremely promising line of work at the CU Cancer Center and elsewhere that aims to prove androgen receptors as an additional driver and target in breast cancer.

“We’re getting closer to being able to call some triple-negative breast cancers, androgen-receptor-positive breast cancers. And we may have to start referring to the remaining triple-negative breast cancers that are completely without androgen receptors as quadruple-negative breast cancers,” Barton says.

The current study treated triple-negative breast cancer cells with the anti-androgen-receptor drug Enzalutamide, currently FDA approved for use as an anti-androgen against prostate cancer. It has been previously shown that Enzalutamide is active against “luminal” triple-negative breast cancer cells that tend to have abundant androgen receptors. Barton and colleagues tested Enzalutamide against non-luminal triple-negative breast cancer cell lines that have far fewer androgen receptors.

“Even in these cells and in mouse models of tumors with low percentage of androgen receptor positive breast cancer cells, we observed that Enzalutamide was significantly effective at reducing proliferation, growth, migration and invasion of cancer cells,” Barton says.

The research is aimed at understanding cancer at the molecular level, with the goal of developing more targeted cancer treatments and markers that can precisely assign patients to specific treatments.

“Participation in ORIEN will greatly leverage the investments in precision medicine we have made at the CU Cancer Center and will accelerate and facilitate innovation by our faculty for the benefit of our patients in Colorado and beyond,” said Dr. Dan Theodorescu, MD, PhD, director of the CU Cancer Center.

Additional nationally designated cancer centers are in the process of joining ORIEN, where partners share de-identified data to accelerate the development of targeted treatments, allowing researchers and clinicians to more quickly match eligible patients to clinical trials and conduct larger and richer analyses.

ORIEN personifies “big data” – extensive databases with cancer patient information (medical history, cancer tissue, DNA) that can be used for basic research and clinical trials. Patients participating in ORIEN will have a greater opportunity to be matched to clinical trials of targeted “smart” drugs.

A Growing Partnership and A National Priority

ORIEN is expanding just as the national spotlight is focused on the promise of precision medicine. President Obama revealed his plan to invest in precision medicine during his State of the Union speech, and on Jan. 30 unveiled the $215 million initiative.

“The growth of ORIEN coincides with President Obama’s announcement and the recognition that molecularly targeted medicine holds tremendous promise for all disease, particularly cancer,” said Michael Caligiuri, MD, director of The Ohio State University Comprehensive Cancer Center and CEO of the James Cancer Hospital and Solove Research Institute. “We believe ORIEN illustrates a collaborative pathway to operationalize personalized medicine to help discover cures for more patients.”

All ORIEN cancer centers will adopt Total Cancer Care®, the protocol created by Moffitt in 2006. The protocol creates a standard system for tracking patient molecular, clinical and epidemiological data. Consented patients are followed throughout their lifetime and agree to be contacted for future studies, playing an active role in the study of their cancer and improving care for future generations.

A Link Between Academia and Industry
M2Gen®, a subsidiary of Moffitt, serves as ORIEN’s operational and commercial provider for support, bringing expertise in data management and informatics. ORIEN’s approach to clinical trial matching presents a significant opportunity for pharmaceutical companies to modernize trial recruitment and facilitate adaptive clinical trial design.

Through M2Gen, industry researchers are able to match their targeted drugs to participating patients within ORIEN cancer center members based on their molecular profile, promoting greater clinical trial precision and flexibility. Ultimately, researchers are better equipped to identify potential candidates for their drug trials, leading to better outcomes. ORIEN also creates the ability to accelerate and improve efficiencies of clinical trials and the drug approval process, including post-market surveillance.

“M2Gen® will facilitate what we view as the ideal way to conduct cancer research and help patients – an approach that promotes collaborative learning at all levels,” said William S. Dalton, PhD, MD, president and CEO of M2Gen. “Our goal with all members of ORIEN is to connect patients to the best treatment options, including clinical trials, by accelerating the discovery and delivery of precision medicine.”

]]>University of Colorado Cancer Center encourages you to Dress in Blue on Friday, March 6, 2015. We are joining University of Colorado Hospital (UCH), Colorado Colorectal Screening Program and the Colon Cancer Alliance to promote awareness of colorectal cancer and to encourage people know their colon cancer risk.

Colon cancer is the second leading cause of overall cancer deaths in the United States. But it doesn’t have to stay this way. Early detection through screening can dramatically reduce your risk. This means having your colon checked regularly starting at age 50, or sooner if you are at higher risk.

March is Colon Cancer Awareness Month and Friday, March 6 is national Dress in Blue Day. We encourage everyone on University of Colorado’s Anschutz Medical Campus to turn the campus blue. We also will be gathering in the lobby of UCH’s Anschutz Cancer Pavilion at 10:00 a.m. for a photo. We are hoping for a great turnout!

Dress in Blue Day is held on the first Friday in March in communities and offices throughout the nation. The Colon Cancer Alliance first launched the Dress in Blue Day program in 2009 to bring nationwide attention to colon cancer and to celebrate the courage of those affected by this disease. Today, individuals, businesses and community groups across the country participate by wearing blue and urging others to do the same. Blue is the nationally recognized color for colon cancer. By “getting blued,” we hope to raise public awareness and save lives.

Like a car’s front and back bumpers, your cell’s chromosomes are capped by “telomeres” that protect this genetic material against deterioration. Still, after enough replications, a chromosome’s telomeres break down and once they reach a certain point of degradation, the cell dies. This is one reason that cells are mortal: telomeres only last so long. That is, unless the enzyme telomerase builds new material onto the worn telomeres to reinforce these chromosomal “bumpers”. Telomere repair can be a good thing, but in some cases it’s not: overactive telomerase can lengthen telomeres until a cell becomes immortal…leading to cancer.

Previous studies blame the gene TERT for reactivating the enzyme telomerase long after its work in healthy cells should be done. And, as you might expect, mutations that turn on the TERT gene are found in many cancer types. Again: more TERT makes more telomerase, which reinforces telomeres, which makes a cell immortal, which causes cancer. The lesson seems simple: turn off TERT and you can stop cancer.

But, like many findings in cancer, it’s not nearly so simple. Despite this seemingly linear storyline, previous studies have been unable to show that a cell’s level of TERT mutations predicts anything about the course of a patient’s cancer – patients with tumors harboring many TERT mutations seem to do just as well as patients with tumors harboring few TERT mutations.

A study published in the journal SCIENCE by University of Colorado Cancer Center members at the University of Colorado at Boulder and Denver looks inside human bladder cancer cell lines and patient genetics to discover why. The answer may help doctors and researchers mark especially aggressive bladder cancers, allowing them to recommend appropriate treatments and improve patient outcomes.

“We show a lot of correlations in the cell lines: TERT mutations are associated with things like more TERT mRNA, more TERT protein, more telomerase activity, and longer telomere lengths. But which of these things that go together is most meaningful to patients’ lives?” says Thomas R. Cech, CU Cancer Center investigator, distinguished professor in the Department of Chemistry and Biochemistry at CU Boulder, winner of the 1989 Nobel Prize in Chemistry, and senior author of the study.

Cech’s research team worked with colleagues including Dan Theodorescu, MD, PhD, professor of Urology and Pharmacology, director of the CU Cancer Center to show that, while there may be little correlation between the presence of TERT mutation and bladder cancer patient outcomes, levels of TERT messenger RNA (mRNA) are highly predictive of cancers that will act aggressively to claim patients’ lives.

“We don’t mean to disregard the influence of TERT mutations. Only, it seems that after these mutations, there are additional mechanics that intercede to create higher telomerase activity, longer telomere length, and poorer patient outcomes,” Theodorescu says.

In other words, it is not simply the presence of TERT gene mutations that lead to cell immortality, but other factors that determine how often the blueprints of the mutated gene are manufactured into the protein it encodes. Sure enough, even among cells that had the same TERT mutations, some cells acted more aggressively than others, and these aggressive cells had fivefold higher levels of TERT protein and fourfold higher levels of telomerase activity. It was not the gene but its expression that made aggressive cancer.

“TERT expression levels directly determine telomerase activity levels,” the authors write. And it is this activity that reinforces degraded telomeres, allowing a cell’s chromosomes to continue replicating into immortality.

The finding has two important implications for patients with bladder cancer. First, by assessing levels of TERT mRNA (which more directly determines TERT protein levels), doctors could in the future pinpoint which patients should be treated with the most aggressive therapies. Second, the finding reinforces the opinion that telomerase reactivation is important for the progression of bladder cancers (and many other types as well), and that perhaps by learning to interrupt the process of telomerase reactivation, we could someday interrupt the progression of the disease itself.

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This work was supported in part by NIH grants CA075115, CA104106, GM08759, and GM099705

]]>0Garth Sundemhttp://www.coloradocancerblogs.org/?p=91902015-02-11T22:43:28Z2015-02-12T13:15:20ZDiscovery that RhoGDI2 blocks action of RhoC to suppress tumors may finally provide a druggable target allowing researchers to manipulate this signaling in a way that reduces tumor metastasis.

Just as malfunctioning genes may promote cancer, some genes seek to suppress it. One of these tumor-suppressing genes is RhoGDI2. However, it has been unclear exactly how RhoGD12 suppresses tumors, making it impossible to design drugs that might enhance or mimic its effect. A collaborative study between the University of Colorado Cancer Center and the University of Virginia published in the journal Molecular Cancer Research demonstrates for the first time a surprising mechanism that RhoGDI2 uses to suppress tumors, namely blocking the action of another gene, RhoC. The work may finally provide a druggable target allowing researchers to manipulate this signaling in a way that reduces tumor metastasis.

“When a tumor loses RhoGDI2 activity, it’s able to grow and spread to other tissue. In fact, that’s how bladder cancer kills – by metastasizing. Our experiment hints at how RhoGDI2 keeps tumors in check. And it points to ways we may be able to accomplish this check on tumor spread, potentially keeping bladder tumors small and in place, and eventually saving lives,” says Dan Theodorescu, MD, PhD, professor of Urology and Pharmacology, director of the CU Cancer Center and the paper’s senior author.

Genes do not act alone and instead are like chains of dominoes in which activation of one gene transmits its action to the next, then the next, causing an entire chain reaction. Theodorescu and colleague David Brautigan PhD, director of the University of Virginia Center for Cell Signaling, asked the seemingly simple question of, if RhoGDI2 were a domino, what dominoes would it directly contact? Answering the question required a proteomic approach using complex mass spectrometry – basically, pull one protein (RhoGDI2) out from the soup made of thousands of proteins inside a bladder cancer cell, notice what comes out together with it. By sorting through the proteins bound to RhoGDI2, the investigators could discover the “dominoes” it influences directly.

The research found that RhoDG12 pulled the protein RhoC from the “soup” of bladder cancer cells. And follow-up experiments showed that decreasing RhoGDI2 levels increased RhoC activity, and increasing RhoGDI2 levels decreased RhoC activity – so not only does RhoGDI2 bind RhoC, but it determines its activity.

The next question was whether RhoC mattered in bladder cancer cells. High levels of RhoC promoted bladder cancer cell growth. Low levels of RhoC slowed growth, slowed the spread of bladder cancer cells, and decreased the cells’ ability to grow into colonies. When the researchers injected cells into mouse models, they found that bladder cancer cells with less RhoC were less able to invade and colonize the lungs (lung metastasis is a common cause of mortality for cancer that starts in the bladder).

“A major goal in bladder cancer is to block the genes that cause cells to form metastases – that is, the growth of cancer cells in other organs. This study is an important step toward understanding the mechanisms that allow bladder cancer to do this. And now with RhoC identified as a promising target that drives metastasis, we may be able to work toward stopping it,” Theodorescu says.

]]>0Garth Sundemhttp://www.coloradocancerblogs.org/?p=91872015-02-11T22:01:26Z2015-02-11T22:01:26Z"Now that patients are living longer with cancer and after cancer, it is becoming more and more important to look at how survivors are living. What is their quality of life and how can we help make it better?" says Whitney Jones, PhD.

“Now that patients are living longer with cancer and after cancer, it is becoming more and more important to look at how survivors are living. What is their quality of life and how can we help make it better?” says Whitney Jones, PhD. Image: Flickr/ Misha Dontsov cc license

Two University of Colorado Cancer Center studies published in the Journal of Psychosocial Oncology show that young adult survivors (ages 18-39) of leukemia and lymphoma are more likely to report high distress than older survivors (ages 65+). Specifically, 45 percent of younger patients report moderate-to-high distress, whereas only 18 percent of older patients report similarly elevated levels. Interestingly, in both groups this distress was not affected by time since treatment – distress was just as likely to be high in survivors who had completed treatment four years prior as in survivors who were three months out of treatment.

“Now that patients are living longer with cancer and after cancer, it is becoming more and more important to look at how survivors are living. What is their quality of life and how can we help make it better?” says Whitney Jones, PhD, the studies’ first author, working with data collected by Carly Parry, PhD, research scientist at Kaiser Permanente, California. Both Jones and Parry are family members of cancer survivors. Jones says, “It was natural – I just kind of fell into survivorship research.”

Jones explains the effect of age on distress using a framework called the Lifespan Perspective. Because there is an expected social, cultural and developmental course of a person’s life, an event (such as cancer) that is highly disruptive in one lifespan stage may be less disruptive in another.

“For younger survivors, cancer is out of context,” Jones says. “When you’re under forty, you’re finishing your education, entering the workforce, starting a family, and cancer may be interpreted as disruptive and unexpected in that phase. On the other hand, some of our older survivors said things like, ‘Cancer isn’t the most difficult thing I’ve experienced in life.’ And they knew friends and family members who had dealt with similar cancer experiences,” she says.

One paper surveyed 477 cancer survivors, using a widely-used measure of distress after trauma and several items from a measure of quality of life in cancer survivors. These measures allowed Jones, Parry and colleagues to ask which factors of a cancer survivor’s life after treatment are the best predictors of persistent distress after treatment completion. Survivors under age 40 had the highest prevalence of distress, while a risk profile showed that a person’s fear of cancer recurrence was the best predictor of elevated distress – people who feared recurrence were most likely to also report high overall distress levels. High financial burden due to cancer treatment also predicted distress.

The second study used interviews with 51 leukemia survivors to explore the human side of these numbers and better understand the sources of distress as articulated by survivors themselves.

“For example, this was before the Affordable Care Act, and we had one survivor who talked about having only the basic college student insurance when he was diagnosed. After treatment he discovered he had substantial medical debt and was uninsurable. It helped to hear survivors talk about their experiences in their own words. To hear them articulate it helped us understand the real struggles behind our data,” Jones says.

Interviews may also help explain why distress lingers even years after treatment ends.

“A patient told us that, after lymphoma treatment, her doctor said that it would take two years to recover physically and mentally, and that almost all the gains would be in these two years,” Jones says. “She said something like, ‘I was really patient for two years, then after those two years passed, I didn’t feel any better and realized this is what I was going to be living with.'”

Distress detection and treatment is increasingly being seen as part of the standard of care for cancer patients and post-treatment survivors. For example, organizations like the National Comprehensive Cancer Network (NCCN) and the American College of Surgeons Commission on Cancer (ACS CoC) mandate distress screening and treatment in order to earn accreditation from these institutions.

“Understanding which individuals are most likely to experience elevated distress,” for example young adult survivors who report fear of recurrence and financial strain due to cancer, “can be useful in targeting interventions to potential participants,” Jones says.